Veterans Care

In 2000, an area of intense focus within VA was the integration of primary care, geriatrics, and mental health. One initiative is the Unified Psychogeriatric Biopsychosocial Evaluation and Treatment (UPBEAT) project, in which elderly patients with symptoms of depression, anxiety, and substance abuse in VA medical and surgical hospital settings are evaluated by an interdisciplinary psychogeriatric team and followed by care coordinators on an outpatient basis. Preliminary results indicate cost savings from fewer hospital days for patients managed in this way. A second initiative is the Primary Care Research in Substance Abuse and Mental Health for the Elderly (PRISMe) project, a four year controlled study cosponsored by VA and the U. S. Department of Health and Human Services. Eleven sites, including five VA-funded sites, will compare two models for delivering mental health and substance abuse services to older adults in primary care settings: One model uses an integrated team of primary care and mental health/ substance abuse professionals, and the other uses referrals to specialty mental health/substance abuse care. A key question to be examined is under what conditions are integrated or referral models most effective in terms of access, treatment adherence, patient outcomes, and cost. A third initiative in this area is the VA’s Primary Care Multidisciplinary Education Committee (PCMEC). In 2000, PCMEC identified over twenty-five innovative and promising models of integrated primary care, mental health, and geriatrics at VA facilities. A variety of educational activities will be developed to evaluate and disseminate best practices from these model programs.

Other innovative projects are underway in the area of dementia care. One is the Chronic Care Networks for Alzheimer’s Disease (CCN/ AD) project, co-sponsored by the National Chronic Care Consortium and the Alzheimer’s Association. VA’s Upstate New York Healthcare Network (VISN 2) is among seven partnerships of health care organizations and Alzheimer’s Association chapters that are testing new, integrated approaches to serving persons with dementia and their families through networks of primary, acute, and long-term care. A set of clinical tools has been developed to facilitate dementia diagnosis and care management in the CCN/AD study sites. A second dementia project is Advances in Home-Based Primary Care for End of Life in Advancing Dementia (AHEAD). Begun in 2000, this project will involve approximately fifteen VA HBPC teams using a rapid cycle change process to improve end of life care at home for individuals with dementia.

In 2000, other significant initiatives were underway as part of the implementation of Public Law 106–117, the Veterans Millennium Healthcare and Benefits Act, which was passed by Congress in November 1999. This major legislation includes numerous provisions related to VA long-term care services, such as inclusion of certain noninstitutional extended care services in the medical benefits package and specification of priority groups for nursing home care.